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Regional anesthesia anticoagulation guidelines

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https://www.readbyqxmd.com/read/27900415/-management-of-anesthesia-in-endovascular-interventions
#1
T Rössel, R Paul, T Richter, S Ludwig, T Hofmockel, A R Heller, T Koch
Cardiovascular diseases are one of the leading causes of morbidity and mortality in Germany. In these patients, the high-risk profile necessitates an interdisciplinary and multimodal approach to treatment. Endovascular interventions and vascular surgery have become established as an important element of this strategy in the past; however, the different anatomical localizations of pathological vascular alterations make it necessary to use a wide spectrum of procedural options and methods; therefore, the requirements for management of anesthesia are variable and necessitate a differentiated approach...
November 29, 2016: Der Anaesthesist
https://www.readbyqxmd.com/read/27536909/paraplegia-after-thoracic-epidural-steroid-injection
#2
Vivek Loomba, Hirsh Kaveeshvar, Samvid Dwivedi
Epidural steroid injections are a common procedure performed by pain physicians. The American Society of Regional Anesthesia along with several other groups recently provided guidelines for performing epidural injections in the setting of anticoagulants. We present a case of a patient who developed an epidural hematoma and subsequent paraplegia despite strict adherence to these guidelines. Although new guidelines serve to direct practice, risks of devastating neurologic complications remain as evidenced by our case...
September 1, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27290980/use-of-direct-oral-anticoagulants-with-regional-anesthesia-in-orthopedic-patients
#3
REVIEW
Gianluca Cappelleri, Andrea Fanelli
The use of direct oral anticoagulants including apixaban, rivaroxaban, and dabigatran, which are approved for several therapeutic indications, can simplify perioperative and postoperative management of anticoagulation. Utilization of regional neuraxial anesthesia in patients receiving anticoagulants carries a relatively small risk of hematoma, the serious complications of which must be acknowledged. Given the extensive use of regional anesthesia in surgery and the increasing number of patients receiving direct oral anticoagulants, it is crucial to understand the current clinical data on the risk of hemorrhagic complications in this setting, particularly for anesthesiologists...
August 2016: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/27076369/initial-experience-of-the-american-society-of-regional-anesthesia-and-pain-medicine-coags-regional-smartphone-application-a-novel-report-of-global-distribution-and-clinical-usage-of-an-electronic-decision-support-tool-to-enhance-guideline-use
#4
Rajnish K Gupta, Matthew D McEvoy
BACKGROUND AND OBJECTIVES: Decision support tools have been demonstrated to improve adherence to medical guidelines; however, smartphone applications (apps) have not been studied in this regard. In a collaboration between Vanderbilt University and the American Society of Regional Anesthesia and Pain Medicine (ASRA), the ASRA Coags Regional app was created to be a decision support tool for the 2010 published guideline on regional anesthesia for patients receiving anticoagulation. This is a review of the distribution and usage of this app...
May 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/26882272/periprocedural-management-of-direct-oral-anticoagulants-comment-on-the-2015-american-society-of-regional-anesthesia-and-pain-medicine-guidelines
#5
James D Douketis, Summer Syed, Sam Schulman
No abstract text is available yet for this article.
March 2016: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/26347411/neuraxial-and-peripheral-nerve-blocks-in-patients-taking-anticoagulant-or-thromboprophylactic-drugs-challenges-and-solutions
#6
REVIEW
Jinlei Li, Thomas Halaszynski
Incidence of hemorrhagic complications from neuraxial blockade is unknown, but classically cited as 1 in 150,000 epidurals and 1 in 220,000 spinals. However, recent literature and epidemiologic data suggest that for certain patient populations the frequency is higher (1 in 3,000). Due to safety concerns of bleeding risk, guidelines and recommendations have been designed to reduce patient morbidity/mortality during regional anesthesia. Data from evidence-based reviews, clinical series and case reports, collaborative experience of experts, and pharmacology used in developing consensus statements are unable to address all patient comorbidities and are not able to guarantee specific outcomes...
2015: Local and Regional Anesthesia
https://www.readbyqxmd.com/read/26135797/purple-glove-syndrome-after-phenytoin-or-fosphenytoin-administration-review-of-reported-cases-and-recommendations-for-prevention
#7
REVIEW
Lyudmila A Garbovsky, Byron C Drumheller, Jeanmarie Perrone
The aim of our study was to identify all previously reported cases of phenytoin- or fosphenytoin-associated purple glove syndrome (PGS) and summarize the most current understanding of the pathophysiology, clinical presentation, diagnosis, and treatment of the disease. We searched the English language references from MEDLINE, EMBASE, CINAHL, TOXNET, and gray literature that featured one or more case descriptions of phenytoin- or fosphenytoin-associated PGS after administration and provided information on the clinical setting of the event and associated outcome(s)...
December 2015: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
https://www.readbyqxmd.com/read/25899949/interventional-spine-and-pain-procedures-in-patients-on-antiplatelet-and-anticoagulant-medications-guidelines-from-the-american-society-of-regional-anesthesia-and-pain-medicine-the-european-society-of-regional-anaesthesia-and-pain-therapy-the-american-academy
#8
Samer Narouze, Honorio T Benzon, David A Provenzano, Asokumar Buvanendran, José De Andres, Timothy R Deer, Richard Rauck, Marc A Huntoon
Interventional spine and pain procedures cover a far broader spectrum than those for regional anesthesia, reflecting diverse targets and goals. When surveyed, interventional pain and spine physicians attending the American Society of Regional Anesthesia and Pain Medicine (ASRA) 11th Annual Pain Medicine Meeting exhorted that existing ASRA guidelines for regional anesthesia in patients on antiplatelet and anticoagulant medications were insufficient for their needs. Those surveyed agreed that procedure-specific and patient-specific factors necessitated separate guidelines for pain and spine procedures...
May 2015: Regional Anesthesia and Pain Medicine
https://www.readbyqxmd.com/read/25899948/about-bloody-time-interventional-spine-and-pain-procedures-in-patients-on-antiplatelet-and-anticoagulant-medications-guidelines-from-the-american-society-of-regional-anesthesia-and-pain-medicine-european-society-of-regional-anaesthesia-and-pain-therapy-american
#9
EDITORIAL
https://www.readbyqxmd.com/read/25693330/-proposal-for-making-guidelines-of-regional-anesthesia-in-patients-under-anticoagulation-therapy-or-antiplatelet-therapy
#10
EDITORIAL
Shinsuke Hamaguchi
No abstract text is available yet for this article.
October 2014: Masui. the Japanese Journal of Anesthesiology
https://www.readbyqxmd.com/read/24565383/sba-recommendations-for-regional-anesthesia-safety-in-patients-taking-anticoagulants
#11
REVIEW
Neuber Martins Fonseca, Rodrigo Rodrigues Alves, João Paulo Jordão Pontes
No abstract text is available yet for this article.
January 2014: Brazilian Journal of Anesthesiology
https://www.readbyqxmd.com/read/24338124/reconsidering-the-switch-from-low-molecular-weight-heparin-to-unfractionated-heparin-during-pregnancy
#12
REVIEW
L D Pacheco, G R Saade, M M Costantine, R Vadhera, G D V Hankins
Venous thromboembolic disease accounts for 9% of all maternal deaths in the United States. In patients at risk for thrombosis, common practice is to start prophylactic doses of low-molecular-weight heparin and transition to unfractionated heparin during the third trimester, with the perception that administration of neuraxial anesthesia will be safer while on unfractionated heparin, as spinal/epidural hematomas have been associated with recent use of low-molecular-weight heparin. In patients receiving prophylactic doses of unfractionated heparin, neuraxial anesthesia may be placed, provided the dose used is 5,000 units twice a day...
September 2014: American Journal of Perinatology
https://www.readbyqxmd.com/read/24335403/new-oral-anticoagulants-and-regional-anaesthesia
#13
REVIEW
H T Benzon, M J Avram, D Green, R O Bonow
The new oral anticoagulants are approved for a variety of clinical syndromes, including the prevention of stroke in atrial fibrillation, acute coronary syndromes, treatment of venous thromboembolism (VTE), and prevention of venous thrombosis after total joint surgery or hip fracture. Published guidelines have differing recommendations on the safe interval between discontinuation of the anticoagulant and performance of neuraxial procedures and between the interventional procedure and redosing of the drug. While two to three half-life intervals might be acceptable in patients who are at high risk for VTE or stroke, an interval of four to six half-lives between discontinuation of the drug and neuraxial injections is probably safer in most patients at low risk of thrombosis...
December 2013: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/23905877/regional-anaesthesia-and-patients-with-abnormalities-of-coagulation-the-association-of-anaesthetists-of-great-britain-ireland-the-obstetric-anaesthetists-association-regional-anaesthesia-uk
#14
(no author information available yet)
Concise guidelines are presented that relate abnormalities of coagulation, whether the result of the administration of drugs or that of pathological processes, to the consequent haemorrhagic risks associated with neuraxial and peripheral nerve blocks. The advice presented is based on published guidelines and on the known properties of anticoagulant drugs. Four separate Tables address risks associated with anticoagulant drugs, neuraxial and peripheral nerve blocks, obstetric anaesthesia and special circumstances such as trauma, sepsis and massive transfusion...
September 2013: Anaesthesia
https://www.readbyqxmd.com/read/23493909/safe-removal-of-an-epidural-catheter-72-hours-after-clopidogrel-and-aspirin-administrations-guided-by-platelet-function-analysis-and-thromboelastography
#15
Eric Glenn, Judson Mehl, Francis A Rosinia, Henry Liu
Management of neuraxial anesthesia/analgesia in anticoagulated patient can be challenging. The shortest safe time to remove epidural catheter, after a patient receives long-acting dual antiplatelet agents (clopidogrel and aspirin), is unclear. American Society of Regional Anesthesiology (ASRA) guidelines recommend seven days interval for the epidural placement after clopidogrel administration. However ASRA Guideline did not specify the time for epidural catheter removal, and did not specify how much time elapse necessary after dual antiplatelet therapy with clopidogrel and aspirin...
January 2013: Journal of Anaesthesiology, Clinical Pharmacology
https://www.readbyqxmd.com/read/23486416/catheter-ablation-in-combination-with-left-atrial-appendage-closure-for-atrial-fibrillation
#16
Martin J Swaans, Arash Alipour, Benno J W M Rensing, Martijn C Post, Lucas V A Boersma
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, affecting millions of individuals worldwide. The rapid, irregular, and disordered electrical activity in the atria gives rise to palpitations, fatigue, dyspnea, chest pain and dizziness with or without syncope. Patients with AF have a five-fold higher risk of stroke. Oral anticoagulation (OAC) with warfarin is commonly used for stroke prevention in patients with AF and has been shown to reduce the risk of stroke by 64%. Warfarin therapy has several major disadvantages, however, including bleeding, non-tolerance, interactions with other medications and foods, non-compliance and a narrow therapeutic range...
2013: Journal of Visualized Experiments: JoVE
https://www.readbyqxmd.com/read/23385605/-polish-guidelines-for-the-prevention-and-treatment-of-venous-thromboembolism-2012-update
#17
Krystyna Zawilska, Małgorzata M Bała, Piotr Błędowski, Dariusz W Chmielewski, Zygmunt Dobrowolski, Mariusz Frączek, Marzena Frołow, Piotr Gajewski, Tomasz Guzik, Roman Jaeschke, Tomasz Korman, Jan Kotarski, Wojciech Kozubski, Marek Krawczyk, Wiesław Kruszewski, Jerzy Kulikowski, Halina Kutaj-Wąsikowska, Ewa Mayzner-Zawadzka, Przemysław M Mrozikiewicz, Jacek Musiał, Rafał Niżankowski, Tomasz Pasierski, Ryszard Poręba, Witold Tomkowski, Adam Torbicki, Anetta Undas, Tomasz Urbanek, Marek Z Wojtukiewicz, Jarosław Woroń, Jacek Wroński
The overall objective of the Polish guidelines for the prevention and treatment of venous thromboembolism is to increase patient benefit and safety by appropriate prevention and treatment of deep vein thrombosis and pulmonary embolism as well as proper management of the complications associated with antithrombotic and thrombolytic therapy. These guidelines apply to adult trauma, cancer, surgical, and medical patients as well as those at increased risk of venous thromboembolism. Specific recommendations have been formulated for pregnant women, patients requiring surgery while receiving long-term oral anticoagulant treatment, and patients undergoing regional anesthesia and/or analgesia...
2012: Polskie Archiwum Medycyny Wewnętrznej
https://www.readbyqxmd.com/read/23351456/-thromboprophylaxis-in-the-perioperative-implications-for-technical-regional-anesthetic
#18
REVIEW
Guadalupe Zaragoza-Lemus, Raúl Carrillo-Esper
BACKGROUND: Thromboprophylaxis in surgical patients requires specific measures to implement regional anesthesia techniques. In this regard the current clinical practice guidelines of anesthesiology summarizes the recommendations of the review of current evidence. OBJECTIVE: We must recognize the general guidelines for thromboprophylaxis and impact modifiers of coagulation for the Surgical Team to implement the actions for each specific patient. DISCUSSION: The most feared event by anesthesiologists is the spinal hematoma, but given its rarity there is a prospective randomized study, nor is there currently a laboratory model...
September 2012: Cirugia y Cirujanos
https://www.readbyqxmd.com/read/22633209/-management-of-direct-action-oral-anticoagulants-in-the-peri-operative-period-and-invasive-techniques
#19
J V Llau, R Ferrandis, J Castillo, J de Andrés, C Gomar, A Gómez-Luque, F Hidalgo, L M Torres
The new direct-acting oral anticoagulants (ACOD) in patients on prolonged treatment require the need to balance the risk of haemorrhage by administering them against the risk of thrombosis on withdrawing them. Recommendations for their management are proposed in the present article: A) Thromboprophylaxis and general anaesthesia: the performing of regional anaesthesia if administered with an ACOD as thromboprophylaxis requires some safety intervals based on their pharmacokinetic parameters; B) Management of ACOD in elective surgery: in patients with normal renal function and a low haemorrhage/thrombosis risk, stop the ACOD two days before the surgery; it the haemorrhage/thrombosis risk is high and/or renal function is impaired, therapy with a low molecular weight heparin is proposed from 5 days prior to the surgery, and C) Management of ACOD in urgent surgery and associated haemorrhage: the systematic prophylactic administration of haemostatics is recommended...
June 2012: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/22504213/the-risk-and-outcomes-of-epidural-hematomas-after-perioperative-and-obstetric-epidural-catheterization-a-report-from-the-multicenter-perioperative-outcomes-group-research-consortium
#20
MULTICENTER STUDY
Brian T Bateman, Jill M Mhyre, Jesse Ehrenfeld, Sachin Kheterpal, Kenneth R Abbey, Maged Argalious, Mitchell F Berman, Paul St Jacques, Warren Levy, Robert G Loeb, William Paganelli, Kelly W Smith, Kevin L Wethington, David Wax, Nathan L Pace, Kevin Tremper, Warren S Sandberg
BACKGROUND: In this study, we sought to determine the frequency and outcomes of epidural hematomas after epidural catheterization. METHODS: Eleven centers participating in the Multicenter Perioperative Outcomes Group used electronic anesthesia information systems and quality assurance databases to identify patients who had epidural catheters inserted for either obstetrical or surgical indications. From this cohort, patients undergoing laminectomy for the evacuation of hematoma within 6 weeks of epidural placement were identified...
June 2013: Anesthesia and Analgesia
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